Psychiatric Bulletin (2005) 29: 233. doi: 10.1192/pb.29.6.233-a
© 2005 The Royal College of Psychiatrists
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Psychiatric Bulletin (2005) 29: 233
© 2005 The Royal College of Psychiatrists

Correspondence

Neuroimaging in dementia

Michael Hughes, Final Year Medical Student and Tom MacEwan, Consultant Psychiatrist

Old Age Psychiatry Directorate, Konord, Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH

We agree with Dr Fielding that neuroimaging in dementia is controversial (Psychiatric Bulletin, January 2005, 29, 21-23). Guidelines vary between the relatively restrictive Royal College of Psychiatrists (1995) statement, referred to by Fielding, to the all-inclusive consensus statement from the American Academy of Neurology (2001) in which computed tomography/magnetic resonance imaging (CT/MRI) is recommended.

We conducted a small audit which has some similar findings to those of Fielding. Out of 32 patients scanned in the past year whose notes were readily accessible, 25 (79%) were referred for CT scan according to College guidelines. Only 1 (3%) potentially reversible cause of dementia was found: an incidental meningioma which was not treated. This rate compares closely with Fielding’s report. We also found a very high prevalence of cerebrovascular disease: ischaemic changes or infarcts being found in 27 patients (85%). This prevalence is much higher than in Fielding’s report, perhaps reflecting variation in radiological reporting and/or geographical variation in the prevalence of this disorder.

The very low incidence of potentially reversible causes may reflect the patient group presenting to old age psychiatry. This may be higher in neurology clinics and other settings. The high prevalence of cerebrovascular disease is perhaps of much greater clinical significance to the old age psychiatrist. There may be treatment implications arising from an emerging view that vascular and Alzheimer pathology co-exist (Langa et al, 2004), and this might be justification for CT as a routine test, as advocated by the draft Scottish Intercollegiate Guideline Network (SIGN).

References

  1. KNOPMAN, D. S., DEKOSKY, S.T., CUMMINGS, J. L., et al (2001) Practice parameter: Diagnosis of dementia (an evidence-based review). Report of the Quality Standard Sub-Committee of the American Academy of Neurology. Neurology, 56, 1143 -1153.[Abstract/Free Full Text]
  2. LANGA, K. M., FOSTER, N. L. & LARSON, E. B. (2004) Mixed dementia. Emerging concepts and therapeutic implications. Journal of the American Medical Association, 292, 2901 -2908.[Abstract/Free Full Text]
  3. ROYAL COLLEGE OF PSYCHIATRISTS (1995) Consensus Statement on the Assessment of an Elderly Person with Suspected Cognitive Impairment by a Specialist Old Age Psychiatry Service (Council Report CR49) . London: Royal College of Psychiatrists.




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